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Environmental Health Department <br />1.Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />5 <br />7. <br />8. <br />SAN JOAQUIN <br />-----COUNTY <br /> Alternate: ( )_________ <br />cd»'n <br />J«D?.«Haze"OnAvenue| s'“®<>n. caliromla 95205 I T 209 468-3420 I F 209 464-0138 | www.sjgov.org/eM <br />06/19/19 Page 7 of 11 TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are ’ <br />the festival coordinator three (3) weeks prior to this event. <br />1-Name of Event: <br />required to return a signed and completed copy of this checklist to <br />Vtxxvw o V <br />The following is information about my organization/business: <br />Name of organization/business:(T7A -pTkJ- S <br />Address: PVc. CA <br />List food to be sold or given to the public: '1^(60 \ <br />I am providing food that is NOT prepared at home: Q'Ves No <br />All food is prepared on-site or is from approved commercial facilities- Yes No <br />Name of facility: ------------------------------phone; { <br />Address of facility: <br />' S aiS pu^ fOllOWin9; (to protect my “"packaged food and food-preparation areas from flies, <br />Mn^comoX t?9 COnstrfuctHed "Either wood, canvas, plastic, similar material and fine mesh fly <br />Si ?; con?pletely encl0SI"g open food areas. It will also have a smooth and cleanable floor (concrete <br />areas from the Sc3 S W°Od are acceptable) and co"str“oted to separate food and food preparation <br /> Other (specify):__ <br />N°te: °perati°nS nOt required t0 provide enclosed b00ths those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />J2^PProved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):_ <br />Electricity is provided for my booth’s use: 0Ves No - ------------------------------- ----------------------------------- <br />1 ,he h01 and “ld hoBlna “f po^ntiauy hazartous <br />1 am Providmg the following hot temperature control for the hot holding of all potentially hazardous foods above <br />O Camp stove Q] stemo & hotel trays <br />H'Oouble steamer steam table & lids <br /> Electric stove top Q Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.